Question 1

A patient who is on renal dialysis is diagnosed with infective endocarditis. What causative organisms are more likely in this patient?&#10;A) Enterococcal organisms&#10;B) Neisseria gonorrhea&#10;C) Pseudomonas aeruginosa&#10;D) Staphylococcus aureus

Accepted Answer

Patients on renal dialysis are at increased risk for infections with Staphylococcus aureus due to frequent vascular access, which can lead to infective endocarditis.

Question 2

A patient has been diagnosed with infective endocarditis and is being treated with empirical antibiotics after blood cultures are inconclusive. The patient develops a severe headache along with transient neurologic changes. What is the likely cause of these symptoms?

A) Extra-cardiac abscess formation
B) Haemophilus infection
C) Mycotic aneurysm
D) Rheumatic heart fever

C

Accepted Answer

The sudden onset of severe headache and transient neurologic changes suggests the development of a mycotic aneurysm. This is a common complication of infective endocarditis, particularly in patients with Staphylococcus aureus infections. Mycotic aneurysm is an outpouching of an artery wall that is weakened by infection and can rupture, causing stroke, hemorrhage or meningitis. It requires urgent management, including neuroimaging and surgical intervention. Choices A and B are less likely to cause these symptoms, and choice D is not relevant to this scenario.

Question 3

A patient has native valve endocarditis (NVE). While blood cultures are pending, which antibiotics will be ordered as empirical treatment?&#10;A) A beta-lactamase-resistant penicillin and an antifungal drug&#10;B) Imipenem-cilastatin and ampicillin&#10;C) Penicillin G and an aminoglycoside antibiotic&#10;D) Vancomycin and quinupristin-dalfopristin

Accepted Answer

The most common organisms causing NVE include Streptococcus and Enterococcus species, which are sensitive to penicillin and aminoglycosides. Therefore, empirical treatment with penicillin G and an aminoglycoside antibiotic is appropriate until the blood culture results are available to guide definitive treatment. Choice A is incorrect because antifungal drugs are not first-line agents for NVE. Choice B is incorrect because imipenem-cilastatin is not typically used for NVE, and the addition of ampicillin would cover Listeria, which is not a common cause of NVE. Choice D is incorrect because quinupristin-dalfopristin is not effective against Streptococcus or Enterococcus. Vancomycin can be used as empirical therapy, but it should not be used alone because it does not cover all potential causative organisms.

Deck 105: Infective Endocarditis